Personal value preferences and attitudes toward people with disabilities

1
Personal value preferences and attitudes toward
people with disabilities

• Evgeny Tartakovsky, Ph.D.,
• Tel-Aviv University, the School of Social Work

2
The studies

1. Nurses and physicians working in HIV Centers in
   Kazakhstan
2. Staff members of community services for people
   with intellectual disability and severe mental
   illness in Israel

3
Background on HIV/AIDS

• 34 million people are living with HIV in the
  world
• 8 million are receiving medical treatment
• In Russia, Ukraine, and Central Asia Republics of
  the FSU the HIV epidemic continues, differently
  from other countries in the world
• Differently from what most people think, HIV is
  not a fatal disease

4
Reactions to PLWHA

• Negative reactions in the general population are
  widespread
• They include
• fear of catching the disease
• dislike of being in contact with terminally ill
  people
• unwillingness to be in contact with immoral
  populations (e.g., intravenous drug users,
  homosexuals, prostitutes)
• concern over being stigmatized
• Negative reactions of medics to PLWHA may result
  in poor patient management, denial or
  postponement of their required treatment, care,
  and support, and compromised quality of care
• Socio-demographic characteristics explain a very
  small proportion of variance in attitudes
• Education, special training, and length of
  practice (consistent with Contact Hypothesis)

5
The specifics of Kazakhstan

• Between 2005-2007, 139 children, 13 of their
  mothers, and two of their fathers were diagnosed
  as HIV positive in the Chimkent Region in
  Southern Kazakhstan
• Before this childrens HIV epidemic, most
  registered HIV-positive people in Southern
  Kazakhstan were drug users
• 21 doctors and nurses were charged for
  professional negligence and for receiving payment
  for unnecessary blood transfusions. Most of them
  were convicted to several years in prison.
  Several of the high-ranking officials at the
  Regional Health Department were fired
• Normality of HIV. Stigmatization. Money. Guilt
  and Anger

6
Values and attitudes

• Human cognitive structures are organized
  according to a hierarchy
• Values constitute the most general and abstract
  part of this hierarchy they reflect the
  individuals preferences across a wide range of
  situations and have a motivational property
• Attitudes are defined as the disposition to
  evaluate an attitudinal object with some degree
  of favor or disfavor they represent the
  individuals preferences in specific conditions
• One of the prominent functions of attitudes is to
  assert personal values

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Values according to Schwartz
Values Definitions
Benevolence Caring for the welfare of the others with whom one is in frequent social contact
Universalism Understanding, appreciation, tolerance, and protection of the welfare of all people and of nature
Tradition Respect, commitment, and acceptance of the costumes and ideas provided by the traditional culture or religion
Conformity Limiting actions and urges that might violate social expectations and norms
Security The need for protection of safety, harmony, and stability of the social structure and of the self
Power Aspiration for social status through gaining control and dominance over other people and resources
Achievement Acquiring personal success through demonstrating competence according to social standards
Hedonism Pursuit of pleasure and sensual satisfaction
Stimulation Valuing variety, aspiration for change, challenge, and excitement
Self-direction Importance of independent thought and action
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Relations among the values
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Hypotheses Values and attitudes towards PLWHA

• Self-enhancement values (especially power) may be
  associated with negative attitudes towards
  out-groups, while self-transcendence values
  (especially universalism) may be associated with
  positive attitudes towards out-groups.
• Conservation values may be associated with
  negative attitudes towards out-groups, while
  openness to change values may be associated with
  positive attitudes towards out-groups
• These assumptions have been supported for
  attitudes towards immigrants, ethnic minorities,
  and homosexuals

10
Participants and procedure

• 87 physicians and 38 nurses working in HIV/AIDS
  Centers in Kazakhstan
• Experience in medicine M(SD)18.6(9.86)
• Experience with HIV M(SD)3.22(3.41)
• The research questionnaires were distributed at
  training seminars

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Instruments Attitudes towards PLWHA

• The AIDS Attitude Scale, AAS (Bliwise et al.,
  1991). This 15-item questionnaire combines items
  measuring three aspects of negative attitudes
  towards PLWHA (a 5-point scale)
• Fear of contagion (e.g., Despite all I know
  about how HIV/AIDS is transmitted, I am still
  afraid of catching it),
• Negative emotions (e.g., I sometimes find it
  hard to be sympathetic towards patients with
  HIV/AIDS),
• Professional resistance (e.g., Given a choice, I
  would prefer not to work with patients with
  HIV/AIDS).
• a.91

12
Value priorities

• The Schwartz Value Survey, SVS (Schwartz, 1992)
• Participants are asked to rate the degree to
  which each value serves as a guiding principle in
  their lives
• 57 items 9-point scale
• a .60 - .81
• Item examples
• Equality (equal opportunity for all)
  
• Inner harmony (at peace with myself)
  
• Social power (control over others, dominance)

13
Pearson correlation coefficients between
socio-democratic characteristics and negative
attitudes towards PLWHA
Variables Negative attitudes towards PLWHA
Age -.08
Gender (1 male 2 female) -.07
Education (1 BA 2 MA) -.04
Family status (1 married or cohabitating 2 single) .04
Religiosity (1 not religious 2 somewhat religious 3 very religious) .05
Occupation (1 doctors 2 nurses) -.05
Years working in medicine -.02
Years working with HIV/AIDS -.44
14
Pearson correlation coefficients between personal
value preferences and negative attitudes towards
PLWHA
Variables Negative attitudes towards PLWHA
Security -.04
Conservation .07
Tradition .21
Benevolence -.23
Universalism -.08
Self-direction -.02
Stimulation .09
Hedonism -.02
Achievement .13
Power .31
15
A multiple regression analysis

• 4 predicting variables years of working with
  HIV/AIDS the values of tradition, benevolence,
  and power.
• F(4,120)11.6 plt.001
• R² .28
• Adjusted R² .25
• Three regression coefficients were significant
• years working with HIV/AIDS (ß -.33)
• tradition (ß .24)
• power (ß .22)

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Discussion

• For those high on benevolence, being empathic and
  caring for their patients provides a pleasant
  sense of satisfaction derived from their
  contribution to the welfare of close others
• General humanism (as expressed in the
  universalism values) was not important. The
  reason is not clear
• Care for PLWHA is inconsistent with the power
  values a low-status population and low salary -gt
  a not prestigious area of specialization
• Care for PLWHA is inconsistent with the tradition
  values a sinful population. However, no
  connection with the degree of religiosity was
  found
• Seniority self-selection and attrition

17
Background on the community services for people
with Intellectual Disability and Severe Mental
Illness in Israel

• The philosophy of supported community living for
  people with ID/SMI
• independent living
• social integration
• working in real jobs
• clients participation in decision-making
  regarding their lives
• Community services
• supported residence
• workshops
• clubs
• outpatient clinics (drugs and psychotherapies)
• People with ID/SMI in community services in
  Israel
• SMI 15,000
• ID 25,000
• About 60 have both SMI and ID

18
Sampling (more or less representative)

• 126 worked in services for people with ID
• 96 worked in services for people with SMI
• The mean age 35
• ¾ females
• 10 managers, 24 social workers, 65 support
  workers
• 80 worked in hostels and supported community
  living residences

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Instruments Attitudes of the staff

• The Community Living Attitudes Scale, CLAS (Henry
  et al., 1996a). This is a 40-item questionnaire
  consisting of four subscales (a 6-point scale
  a0.76-0.83)
• The Empowerment scale (13 items) measures the
  degree to which respondents believe that people
  with ID/SMI should be allowed to make their own
  decisions (e.g., People with ID/SMI are the best
  people to give advice and counsel to others who
  wish to move into community living).
• The Exclusion scale (8 items) measures the
  respondents desire to exclude people with ID/SMI
  from community life (e.g., The best way to
  handle people with ID/SMI is to keep them in
  institutions).
• The Sheltering scale (7 items) measures the
  extent to which the respondents believe that
  people with ID/SMI require protection from harm
  (e.g., People with ID/SMI need someone to plan
  their activities for them).
• The Similarity scale (12 items) measures the
  degree to which respondents believe people with
  ID/SMI share a common humanity with others (e.g.,
  People with ID/SMI can have close personal
  relationships just like everyone else).

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Instruments Value preferences

• The latest version of the Portrait Values
  Questionnaire (Schwartz et al., 2012)
• 57 items describing a person
• A 6-point scale a0.72-0.87
• Item examples
• It is important to him to form his own opinions
  and have original ideas (self-direction)
• Being very successful is important to him
  (achievement)

21
Pearson correlation coefficients between the
socio-demographic variables and attitudes
Socio-demographic characteristics Empowerment Similarity Exclusion Sheltering
Group (1-SMI) -.42 -.27 .17 .40
Gender(1-male) .01 .06 .00 -.03
Age -.04 -.08 .06 .03
Origin (1-Isr.) .02 -.12 .10 .07
Education .30 .29 -.19 -.33
Religiosity .03 .00 -.01 .02
Seniority .01 .01 -.05 -.03
Position (1-SW) -.20 -.26 .31 .28
Place (1-hostel) -.01 .07 -.05 -.07
22
Pearson correlation coefficients between value
preferences and attitudes
Values Empowerment Similarity Exclusion Sheltering
Self-direction .22 .26 -.19 -.12
Stimulation -.02 -.04 .02 -.00
Hedonism .09 -.02 -.06 -.04
Achievement -.05 .05 .05 -.06
Power -.26 -.34 .36 .13
Security -.05 -.09 .00 .05
Conformity -.02 -.10 .05 .05
Tradition -.02 .01 -.06 .09
Benevolence .15 .34 -.23 -.16
Universalism .15 .20 -.20 -.07
23
A multiple regression analysis

• Socio-demographic values R²
• Empowerment 26
• Similarity 18
• Exclusion 14
• Sheltering 29
• Values addition ?R²
• Empowerment 5
• Similarity 12
• Exclusion 12
• Sheltering 0

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Discussion A positive effect of the
self-transcendence values

• Different mechanisms
• Benevolence satisfaction and pleasure in caring
  for others who belong to the in-group
• Universalism general humanist approach,
  appreciation of equal rights for all, and
  willingness to accept people unlike yourselves

25
Discussion A positive effect of the
self-direction values

• Support for the philosophy of community living
  requires a certain degree of independent thought,
  reliance upon one's own judgment, and comfort
  with diversity
• societys resistance to community living for
  people with ID/SMI
• No connection between the conservation values and
  community living attitudes
• A tradition of community care for people with
  ID/SMI in collectivistic cultures

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Discussion A negative effect of the power values

• Community living contradicts the goals of
  achieving control and dominance over people and
  resources
• The philosophy of community living assumes
  transferring control to the people with ID/SIM
• A low social status and prestige of working in
  community services
• A sense of helplessness and hopelessness
  vis-à-vis people with ID/SIM

27
Discussion The effect of socio-demographic
characteristics

• SMI (a more positive attitude) vs. ID
• A more educated staff -gtbetter knowledge
• More established services (a longer history of
  services and a stronger state support)
• Managers and SW have a more positive attitudes
  than community support workers
• A higher education -gt more knowledge and less
  fear
• A less intensive contact with the clients
• Managers stronger adhere to the organizational
  norms and values than the frontline workers

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Practical considerations

• Selection of the professionals a higher
  preference for the self-direction, universalism,
  and benevolence values a lower preference for
  the power and (for some areas) tradition values
• Self-awareness regarding ones own value
  preferences the imagined values vs. the real
  ones gt value confrontation
• Value-change focused trainings (especially in the
  beginning of the career)
• Proclamation of the organizational values
• Analysis of the staffs values increasing
  salience of the desired values and decreasing
  salience of the undesired values
• Analysis of the connections between values,
  attitudes, and behavior
• More information about the nature of the clients
  problem may change the motivational meaning of
  working with them (fighting helplessness and
  hopelessness)
• Raising the status of people working with people
  with disabilities

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Thank you!